tbuckley/cabot-search huggingface dataset:
Physician Referrals in a Competitive Environment
Authors: John K. Glenn
Journal: JAMA (1987)

Beyond offering optimum care for individual patients, physician referrals have a cumulative economic impact on many components of the broader medical care system. This article offers an approximation of the magnitude of that impact. By retrospectively reviewing financial records associated with 225 referrals from fee-for-service, rural family practice sites to university-based specialist colleagues, we found that the average referral generated $2944 in combined hospital charges and professional fees within a six-month period after referral. Almost half (110/225, or 49%) of those referrals resulted in a hospital admission and 72% of all revenue associated with referral accrued to the hospital. A second and more detailed study of 97 referrals showed that only 18% of total revenue resulting from referrals accrued to the physician to which the patient was initially referred. We argue that control over volume and destination of referrals, historically the referring physician's prerogative, is susceptible to change in our rapidly restructuring medical care system. In the future, no economic entity that benefits from physician referrals should take for granted those referrals or their impact. (<i>JAMA</i>1987;258:1920-1923)
ACC/AHA guidelines for the clinical application of echocardiography
Authors: Gordon A. Ewy, Christopher P. Appleton, A.N.thony N. Demaria, Harvey Feigenbaum, J.A.mes A. Ronan, David J. Skorton, Abdul J. Tajik, R.O.berta G. Williams, E.D.win W. Rogers, Charles Fisch, George A. Beller, R.O.man W. DeSanctis, Harold T. Dodge, J.Ward Kennedy, T.Joseph Reeves, Sylvan Lee Weinberg
Journal: Journal of the American College of Cardiology (1990)
Aluminum "Pop Tops"
Authors: John D. Burrington
Journal: JAMA (1976)

In a 3 1/2-year period, seven children have been treated for complications of ingestion or aspiration of pull tabs from aluminum beverage cans. One child died from a fistula between the esophagus and a branch of the aortic arch, and two children suffered esophageal perforation with local abscess formation. Since aluminum absorbs x-rays poorly, the pull tabs cannot be seen in frontal projection if they overlie vertebral bodies. Any toddler with unexplained alteration of feeding habits or persistent respiratory symptoms requires evaluation for an aspirated or ingested foreign body. (<i>JAMA</i>235:2614-2617, 1976)
PREVENTION OF CHRONIC HBsAG CARRIER STATE IN INFANTS OF HBsAG-POSITIVE MOTHERS BY HEPATITIS B IMMUNOGLOBULIN
Authors: HenkW. Reesink, EvelineE. Reerink-Brongers, BepJ.Th. Lafeber-Schut, Jo Kalshoven-Benschop, HenkG.J. Brummelhuis
Journal: The Lancet (1979)
The Introduction of Low-Osmolar Contrast Agents in Radiology
Authors: Peter D. Jacobson
Journal: JAMA (1988)

This case study of the public policy implications of introducing a new technology in radiology, namely, low-osmolar contrast media (LOCM), raises the issues of whether and how to place appropriate limits on new technologies. Although these contrast media represent small episodic costs, they may add up to an aggregate expenditure of nearly $1 billion per year if used for all contrast injections. As a result, this technology raises a number of important medical, economic, legal, and public policy questions. Our cost-effectiveness analysis and an analysis of the medical evidence suggest that LOCM should be limited to high-risk patients. We discuss in this article how the legal system might respond to such limitations, and we consider various public policy options for adopting restrictions on use. We conclude that the medical profession should take the lead in developing protocols for appropriate assessment, reimbursement, and use of LOCM. (<i>JAMA</i>1988;260:1586-1592)
The Immunization of Children Enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC)
Authors: Guthrie S. Birkhead
Journal: JAMA (1995)

<h3>Objective.</h3> —To assess the impact of different interventions to increase measles vaccination coverage among preschool children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC). <h3>Design.</h3> —Public health intervention trial. <h3>Setting.</h3> —Six volunteer WIC sites in New York City. <h3>Study Participants.</h3> —Children aged 12 to 59 months presenting for WIC certification between April 1 and September 30, 1991, who were eligible for measles vaccination. <h3>Interventions.</h3> —Two WIC sites were assigned at random to one of three immunization strategies: (1) escort: child was escorted to a nearby pediatric clinic for immunization; (2) voucher incentive: the family returned monthly, rather than every 2 months, to pick up WIC food vouchers until the child was immunized; or (3) referral: the family was passively referred for immunization. <h3>Main Outcome Measure.</h3> —Proportion of eligible children receiving measles vaccination. <h3>Results.</h3> —Of children eligible for measles immunization, 74% (618/836) were immunized. Children at escort sites were 5.5 times (relative risk [RR]=5.5; 95% confidence interval [CI], 3.7 to 8.1) and those at voucher incentive sites were 2.9 times (RR=2.9; 95% CI, 1.9 to 4.5) more likely to be immunized than children at referral sites. Children were immunized more rapidly at escort sites (median, 14 days) and voucher incentive sites (median, 26 days) than at referral sites (median, 45 days;<i>P</i>&lt;.001). <h3>Conclusions.</h3> —Both escort and voucher incentive models resulted in more children being immunized more rapidly than passive referral. Because of ease of administration, voucher incentives may be a more suitable immunization intervention for use at WIC sites, with addition of escort where feasible. (<i>JAMA</i>. 1995;274:312-316)
The Psychotomimetic Drugs
Authors: Jonathan O. Cole, Martin M. Katz
Journal: JAMA (1964)

FOR MANY YEARS several pharmacologically similar drugs—lysergic acid diethylamide (LSD-25), psilocybin, and mescaline, among others—have been of special scientific interest. In volunteer subjects, they have been known to produce a variety of intense and unusual psychic effects. These include bizarre visual phenomena, ranging from a heightening of the apparent brightness or beauty of colored objects in the environment, through distortions in the perceived nature or meaning of real objects (illusions) to true visual hallucinations of colors, shapes, or even of complex scenes or events. These visual phenomena are usually accompanied by intense and often rapidly shifting emotional experiences (ranging from mild apprehension to panic, severe depression or mystical elation) or by concurrent emotions (such as depression and joy) which are not experienced simultaneously under ordinary conditions. Subjects describe changes in body image, the body or its parts appearing larger or smaller, intense feelings of depersonalization, including states in which the subject believes he is
Psychiatric Peer Review: The Ohio System
Authors: Roy R. Miller, Gordon C. Black, Paul Y. Ertel, Gordon F. Ogram
Journal: American Journal of Psychiatry (1974)

The authors describe the development, implementation, and impact of a peer review system that evolved out of a partnership between a state mental health department and a state medical society. From a computer-based, physician-directed medical peer review process, a psychiatric peer review system was established that adheres scrupulously to the ethic of confidentiality and has built-in internal checks. At the heart of the review process are criteria generated by a consensus of practicing physicians.
Septicemia and Total Parenteral Nutrition
Authors: James D. Dillon
Journal: JAMA (1973)

Septic episodes in 122 patients receiving total parenteral nutrition (TPN) were analyzed to determine criteria helpful in distinguishing catheterrelated septicemia from septicemia due to other causes. The five patients (4.1%) with catheter-related septicemia had positive blood and cathetertip cultures with the same organism and no other site of infection with that organism. Four of the six organisms recovered were either<i>Candida</i>or staphylococci. The 14 patients (11.5%) with septicemia due to other causes had positive blood cultures but negative catheter-tip cultures. Another site could be demonstrated to be infected with the same organism and was thought to be the origin of the bacteremic episode. Of the organisms recovered, 83% were gram-negative bacilli or enterococci. The implication of TPN catheters in the genesis of septicemia may be exaggerated in the literature.
The Austin, Texas, Diphtheria Outbreak
Authors: Victor M. Zalma
Journal: JAMA (1970)

During a 19-month period, October 1967 through April 1969, an outbreak of 88 cases of diphtheria occurred in Austin, Tex. Most of the cases were considered mild, and the severe illness, including three deaths, affected only poorly immunized persons. In spite of a mass immunization campaign at the height of the epidemic, cases continued to occur. The outbreak probably began from endemic foci; incomplete immunizations, lack of immunizations, crowding, and poor environmental and personal hygiene probably contributed to the spread of the disease. The evidence suggests that a level of immunization above 90% for all age groups could prevent community-wide diphtheria.
Infant Mortality Among Hispanics
Authors: José E. Becerra
Journal: JAMA (1991)

In the United States, infant mortality risks among Hispanics have not been previously evaluated at the national level. We used the 1983 and 1984 national Linked Birth and Infant Death data sets to compare infant mortality risks among single-delivery infants of Hispanic descent with those among single-delivery infants of non-Hispanic whites (the reference group). We also included the 1983 and 1984 linked birth cohort for single-delivery infants in Puerto Rico. Among all Hispanic groups, the neonatal (&lt;28 days) mortality risk was higher among Puerto Rican islanders (relative risk [RR] = 2.3) and continental Puerto Ricans (RR = 1.5) and lower among Cuban-Americans (RR = 1.0) and Mexican-Americans (RR = 1.0). The postneonatal mortality risk (28 to 364 days) was highest among continental Puerto Ricans (RR = 1.2) and lowest among Cuban-Americans (RR =0.6). Our study underscores the heterogeneity of the Hispanic population in the United States and suggests that interventions to prevent infant mortality be tailored to ethnic-specific risk factors and outcomes. (<i>JAMA</i>. 1991;265:217-221)
Treatment of Photoaged Skin With Topical Tretinoin Increases Epidermal-Dermal Anchoring Fibrils
Authors: David T. Woodley
Journal: JAMA (1990)

Topical 0.1% tretinoin or vehicle control was applied daily to the forearm skin of six caucasian adults for 4 months. Two-millimeter punch biopsy specimens were obtained from treatment sites at the beginning and end of the study period for electron microscopy. Anchoring fibrils within the epidermal-dermal junction of skin treatment sites were quantitated by blinded, standardized, computer-assisted morphometry. After 4 months of continual daily treatment, skin sites that received topical tretinoin showed double the anchoring fibril density compared with vehicle control sites (1.34 anchoring fibrils per micron of lamina densa vs 0.65, respectively). The possible mechanisms by which topical tretinoin increases anchoring fibrils in skin include the drug's property of inhibiting collagenase, a dermal enzyme that degrades anchoring fibril collagen. We speculate that increased numbers of collagenous anchoring fibrils within the papillary dermis of human skin is one of the connective-tissue correlates of the clinical improvement observed in photoaged skin after treatment with topical tretinoin. (<i>JAMA</i>. 1990;263:3057-3059)
Capitation or Decapitation
Authors: Thomas S. Bodenheimer
Journal: JAMA (1996)

Violet Fairbanks is disgusted. The meeting, a negotiating session for a physician-hospital managed care agreement, has degenerated into mutual name-calling. Dr George Capwell accuses the hospital of picking his pocket and sending him into financial ruin. Jack Powers, hospital administrator, fingers the physicians as the cause of the hospital's fiscal problems. The meeting ends in chaos. The following morning, the physician leadership of the CapCap Independent Practice Association (IPA) meets. Hitherto, Dr Fairbanks has steered clear of managed care politics. Now, curiosity and mistrust of the hospital and of some physician leaders have brought her to meetings as a spectator. As the CapCap IPA leaders plan their negotiating tactics, Dr Fairbanks timorously raises her hand. "Does it have to be like this? Can't we give in a bit, ask them to give in a bit, get this behind us, and go back to practicing medicine?" She leaves the room at
Managed Care&lt;subtitle&gt;A Product of Market Dynamics&lt;/subtitle&gt;
Authors: David F. Drake
Journal: JAMA (1997)

The development of managed care is described as an unexpected product of competition between public and private purchasers of health care. Managed care is a series of purchasing techniques that employers have applied to reduce the cost of their employees' health benefits. Its most significant use has been as a device for bargaining with individual health care providers by encouraging or requiring employees to purchase health care services from a select set of providers. Selective contracting has broken a 40-year-old barrier to price competition among health care providers, who have responded to this negotiating tactic by forming or joining larger organizational units to strengthen their bargaining power. Although the so-called managed care revolution has reduced the rate of increase in health care costs by creating a more competitive price environment, it is simply a start toward a more effective health care market. It is very much a work in progress that will affect and be affected by both political and market changes occurring over the remainder of this century.
Metronidazole for Vaginal Trichomoniasis
Authors: W. David Hager
Journal: JAMA (1980)

This randomized, double-blind evaluation of metronidazole therapy for trichomonal vaginitis compared the efficacy and side effects of a single 2-g dose and the standard seven-day regimen (250 mg three times daily). Eighty (86%) of the 93 women examined seven to 21 days after therapy with the 2-g regimen, and 76 (91.6%) of 83 examined after the seven-day regimen, were cured. These cure rates were not significantly different. In addition, symptom duration and the occurrence of side effects and yeast infection were not significantly different for the two treatment groups. Because the efficacy and side effects of the two regimens are comparable and the 2-g dose is easier to administer and less expensive, we recommend the 2-g dose as standard treatment for trichomoniasis. (<i>JAMA</i>244:1219-1220, 1980)
Association of Shower Use With Legionnaires' Disease
Authors: Robert F. Breiman
Journal: JAMA (1990)

OUTBREAKS of legionnaires' disease (LD) have been linked to aerosols from evaporative condensers and cooling towers,<sup>1,2</sup>whirlpool spas,<sup>3</sup>respiratory therapy equipment,<sup>4</sup>and humidifiers.<sup>5</sup>An association between shower use and LD has been hypothesized but not epidemiologically demonstrated.<sup>6-11</sup>Prevention of LD is limited by a lack of understanding of the ecology of<i>Legionella pneumophila</i>. Monitoring aerosolproducing sites for<i>L pneumophila</i>can be misleading since the bacteria are found often in water sources without a known disease association.<sup>12</sup> Factors essential for<i>Legionella</i>multiplication in water are poorly understood, but the bacteria multiply extracellularly on supplemented culture media.<sup>13,14</sup>Nutritional requirements of the genus are unlikely to be met in most water sources; however, these bacteria do multiply inside protozoa,<sup>15-17</sup>which are common to aquatic environments.<i>Legionella pneumophila</i>grows in water samples with amoebae but not in those without viable amoebae.<sup>17</sup>Recognition of the association
Implementing research findings in developing countries
Authors: A. Hill, K. Enock, C. Brogan, T. Gibbs
Journal: BMJ (1999)

Deprivation and emergency admissions for cancersOther possible explanations for findings need to be explored Editor-The reasons for Pollock and Vickers's findings about the relation between deprivation and emergency admissions for cancers remain speculative. 1To impute the differences in care to failures of primary care seems unfair at this stage.The authors discuss a range of possible explanations, but many other could also be relevant.Day case treatment may require a certain level of facilities at home that are less commonly available in deprived areas.The presence of another adult at home may also be a prerequisite.Single people may be more likely to live in deprived areas; patients from deprived areas may be more likely to have a working partner who cannot afford to take time off work or who has a job where such absences would be unacceptable.Patients with lung cancer due to smoking (more common in areas where smoking is more prevalent) may be less likely to have an operable malignancy because of concomitant disease related to smoking.The authors mention this in their discussion, but limiting the study to inpatient finished consultant episodes with a primary diagnosis of any of the three cancers of interest does not give any information about comorbidity.I hope further research will be carried out to help elucidate the reasons behind the apparently inequitable access and treatment decisions that Pollock and Vickers have found.Both qualitative and quantitative research methods could be used to study patients' and professionals' experiences as patients pass through the system.Perhaps allocation of blame should wait until such results are available.
Malnutrition in the Hospital
Authors: C. E. Butterworth
Journal: JAMA (1974)

Hardly anyone would argue with the contention that adequate nutrition is essential to the maintenance of health and to recovery from injury or illness. There might be considerable debate concerning the definition of "adequate," and what methods should be employed to deliver nutritional requirements under conditions of increased needs. Almost everyone would agree, however, that the physician has an obligation to make every effort to provide the things necessary to sustain life, particularly when the patient is unable to provide them for himself. This includes carbohydrates, proteins, fats, vitamins, and minerals, as well as antibiotics, pacemakers, respirators, and artificial organs. There is now a growing body of evidence that the nutritional support of hospitalized patients is far from ideal.<sup>1-3</sup>In fact, it could be described as shocking. Elsewhere in this issue (p 858), Bistrian et al present the findings of a survey carried out in a large urban hospital.
Repurposing digoxin for geroprotection in patients with frailty and multimorbidity
Authors: Helena Lee, Daisy Wilson, Karina V. Bunting, Dipak Kotecha, Thomas Jackson
Journal: Ageing Research Reviews (2023)

The geroscience hypothesis proposes biological hallmarks of ageing are modifiable. Increasing evidence supports targeting these hallmarks with therapeutics could prevent and ameliorate age-related conditions - collectively termed "geroprotector drugs". Cellular senescence is a hallmark with considerable potential to be modified with geroprotector drugs. Senotherapeutics are drugs that target cellular senescence for therapeutic benefit. Repurposing commonly used medications with secondary geroprotector properties is a strategy of interest to promote incorporation of geroprotector drugs into clinical practice. One candidate is the cardiac glycoside digoxin. Evidence in mouse models of pulmonary fibrosis, Alzheimer's disease, arthritis and atherosclerosis support digoxin as a senotherapeutic agent. Proposed senolytic mechanisms are upregulation of intrinsic apoptotic pathways and promoting intracellular acidification. Digoxin also appears to have a senomorphic mechanism - altering the T cell pool to ameliorate pro-inflammatory SASP. Despite being widely prescribed to treat atrial fibrillation and heart failure, often in multimorbid older adults, it is not known whether digoxin exerts senotherapeutic effects in humans. Further cellular and animal studies, and ultimately clinical trials with participation of pre-frail older adults, are required to identify whether digoxin has senotherapeutic effect at low dose. This paper reviews the biological mechanisms identified in preliminary cellular and animal studies that support repurposing digoxin as a geroprotector in patients with frailty and multimorbidity.
Highly pathogenic avian influenza A(H5N1) virus infection in farmed minks, Spain, October 2022
Authors: Montserrat Agüero, Isabella Monne, Azucena Sánchez, Bianca Zecchin, Alice Fusaro, María José Ruano, Manuel del Valle Arrojo, Ricardo Fernández-Antonio, Antonio Manuel Souto, Pedro Tordable, Julio Cañás, Francesco Bonfante, Edoardo Giussani, Calogero Terregino, Jesús Javier Orejas
Journal: Eurosurveillance (2023)

In October 2022, an outbreak in Europe of highly pathogenic avian influenza (HPAI) A(H5N1) in intensively farmed minks occurred in northwest Spain. A single mink farm hosting more than 50,000 minks was involved. The identified viruses belong to clade 2.3.4.4b, which is responsible of the ongoing epizootic in Europe. An uncommon mutation (T271A) in the PB2 gene with potential public health implications was found. Our investigations indicate onward mink transmission of the virus may have occurred in the affected farm.
Author’s correction for Euro Surveill. 2023;28(2)
Journal: Eurosurveillance (2023)

© This work is licensed under a Creative Commons Attribution 4.0 International License. Closure This is a corrected article applying to the following content: Countrywide multi-serotype outbreak of Salmonella Bovismorbificans ST142 and monophasic Salmonella Typhimurium ST34 associated with dried pork sausages in France, September 2020* to January 2021
Preparing Europe for future health threats and crises – key elements of the European Centre for Disease Prevention and Control’s reinforced mandate
Authors: Maarit Kokki, Andrea Ammon
Journal: Eurosurveillance (2023)

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